nursing care plan for HYPOKALEMIA plsss.

  1. good day. im from Philippines, i've been having problem doing nursing care plan. i need a guide and if lucky a possible NCP for HYPOKALEMIA.

    Medical Dx--- Hypokalemia periodic paralysis
    short and long term goals? thanks
  2. Visit dolphyrn profile page

    About dolphyrn

    Joined: Jul '08; Posts: 2


  3. by   Daytonite
    hi, dolphyrn, and welcome to allnurses!

    all care planning is problem solving. we use the nursing process to problem solve. there are 5 steps to the nursing process and the first three are critical in starting the care plan:
    1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
    2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
    3. planning (write measurable goals/outcomes and nursing interventions)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
    the first thing you need to do is what step #1 tells you: assessment. these things are very specific to nursing assessment:
    • a physical assessment of the patient
    • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease; the adls include bathing, dressing, mobility, eating, toileting, and grooming; you would evaluate how individuals function within their homes, workplaces, and social environments
    • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
    • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
      • you can find lots of weblinks to information about medical diseases and their treatment on this sticky thread in the nursing student assistance forum: - medical disease information/treatment/procedures/test reference websites
        • periodic paralysis
        • hypokalemia
          • - low potassium (hypokalemia) symptoms: muscle weakness, muscle aches, and muscle cramps. diagnosis: blood tests and electrocardiogram. treatment: potassium replacement
          • - "hypokalemia is serum k concentration < 3.5 meq/l caused by a deficit in total body k stores or abnormal movement of k into cells. the most common causes are excess losses from the kidneys or gi tract. clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. diagnosis is by serum measurement. treatment is administration of k and addressing the cause." the pathophysiology follows.
          • from my own files:
              • lab values of potassium:
                • normal adult:
                  • 3.5-5.0 meq/liter
                  • 3.5-5.0 mmol/liter
                • normal child:
                  • 3.4-4.7 meq/liter
                  • 3.4-4.7 mmol/liter
                • normal urine in adult:
                  • 26-123 meq/24 hrs
                  • 26-123 mmol/24 hrs
                • panic (critical) values:
                  • below 2.5 meq/liter
                  • above 6.5 meq/liter
              • symptoms of hypokalemia
                • shallow respirations
                • dizziness
                • hypotension
                • arrhythmias with ekg changes: st segment depression, flattened t waves, prominent u waves
                • ventricular arrhythmias
                • thready pulse
                • cardiac arrest
                • nausea/vomiting
                • anorexia
                • diarrhea
                • decreased contractility of smooth, skeletal and cardiac muscles
                • decreased peristalsis
                • abdominal distention
                • decreased bowel (intestinal) motility/intestinal ileus
                • muscle weakness
                • muscle cramps
                • irritability
                • confusion
                • weakness initially in the legs, particularly the quadriceps, then in the arms followed by involvement of the respiratory muscles
                • dilute urine
                • polyuria
                • polydipsia (thirst)
                • lethargy
                • fatigue
                • leg cramps
                • cardiac arrest
              • foods high in potassium:
                • vegetables:
                  • potatoes
                  • squash
                  • tomatoes
                  • mushrooms
                  • dried beans
                  • lima beans
                  • carrots
                  • spinach
                  • asparagus
                  • broccoli
                  • artichokes
                • fruits:
                  • figs
                  • dates
                  • raisins
                  • cantaloupe
                  • bananas
                  • apricots (raw)
                  • peaches (raw)
                  • pears (raw)
                  • apricots (dried)
                  • orange juice
                • meats:
                  • scallops
                  • veal
                  • chicken
                  • beef
    it is important that after doing all this research that you match what you have found against what you observed in your patient. why? because as a student you don't always see what is in front of you when you are with a patient. this is how you will learn. this is how you will remember to assess the next patient you have with the same or similar condition. with periodic paralysis you want to know what brings on the attacks of weakness so you can develop nursing interventions to help the patient either prevent them from happening or how to treat them.

    after finding all that information, you are ready to move on to the next step in care planning--determining the patient's problems and nursing diagnoses. to do this you need to make a list of all the abnormal information you observed in the patient. this abnormal information, or you could call them symptoms, are the evidence (proof) that supports the nursing problems that you must figure out they fit with. every nursing diagnosis (nursing problem) has a defined list called defining characteristics by nanda, the north american nursing diagnosis association, that identifies what that nursing problem consists of. your job is to figure out what nursing diagnosis your patient's abnormal data belong with.

    once you have done that you can move on to the third step which is the caregiving part of the care plan--writing goals/outcomes and nursing interventions. both of these are based upon that abnormal data that you found and collected during your assessment of the patient and that you use to support the various nursing diagnoses that you chose.

    as you can see, what you do during your assessment activity is extremely important to what goes into your care planning. knowing that the patient has hypokalemia and, specifically, periodic paralysis because of hypokalemia is only a beginning. do you see all the information i began to generate from those two pieces of information? and, i didn't even get into the actual choice of any nursing diagnoses, goals or nursing interventions! i'll leave that to you. i've given you a good start in the right direction. let's see what you can do with this.
  4. by   Daytonite
    there is information on writing care plans on this sticky thread:
  5. by   dolphyrn
    thanks! we will be having our grand case presentation by next week. i have a question, what causes hypokalemia? what will be the system involved in hypokalemia? kidney?
  6. by   Daytonite
    I gave you a number of weblinks that have that information on them. Your question tells me that you did not read any of them. That saddens me because I spent a great deal of time putting that post together for you. Read the information on the weblinks!
  7. by   ADPIE10
    Just a quick thought... Make sure that the hypokalemia isn't the result of hyperthyroidism. Some patients with hyperthyroidism experience hypokalemic periodic paralysis after consumption of large CHO meals. I know because I had it :-)
  8. by   suzy253
    Quote from Daytonite
    I gave you a number of weblinks that have that information on them. Your question tells me that you did not read any of them. That saddens me because I spent a great deal of time putting that post together for you. Read the information on the weblinks!

    allow me to say thank you for all your continued hard work!
  9. by   SusanKathleen, RN
    Thanks, Daytonite. Your work was not in vain!
  10. by   stormymemphis
    risk for decreased cardiac output related to abnormal cardiac functioning secondary to electrolyte imbalance
  11. by   tsible03
    In caring for a client with hypokalemia, what is the nurse's highest priority?
    -Provide adequate oral fluid intake
    -position to increase circulation
    -administer supplemental sodium
    -monitor for cardiac dysrhythmia
  12. by   loricatus
    What do you think is the correct answer & why? I'll be able to help you if you can answer that.
  13. by   Daytonite
    in caring for a client with hypokalemia, what is the nurse's highest priority?
    -provide adequate oral fluid intake
    -position to increase circulation
    -administer supplemental sodium
    -monitor for cardiac dysrhythmia
    you have a problem here and the way you go about solving it is to use the nursing process to help you. (did you read what i posted above?)

    step #1 assess - look up the signs and symptoms of hypokalemia. knowing how a disease progresses and gets worse when left untreated is part of understanding the disease. doctors, as well as we nurses, treat the symptoms that diseases and conditions cause and generally the priority of treatment involves which symptom(s) are the worst or would cause the patient more trouble if something is not done about them before others.
    step #2 - determine the patient's problem - based on what you learn about hypokalemia, what problem(s) will this patient most likely have as a result of the low potassium level? which one(s) will result in the patient dying if something is not done for it asap?

    step #3 - plan of action. now you can answer your question. remember that there are things that only a doctor can do and things that nurses can do. the highest priority of care will be a nursing action that will be helpful in some way to:
    • assess/monitor/evaluate/observe the patient's condition
    • care/perform/provide/assist in performing actual patient care
    • teach/educate/instruct/supervise the education of the patient or caregiver
    • manage/refer/contact/notify the care on behalf of the patient or caregiver
    in this particular case, you are given 4 choices. three of them are clearly wrong if you read the information about hypokalemia. the hint i will give you is that after reviewing the answer choices, the correct response involves observing and monitoring the patient's condition. do you understand why that is the answer and not any of the others?
  14. by   tsible03
    I am taking a pharmacology class as one of my prerequisites before the nursing program. This was one of the questions asked on a take home assignment. The four statements below the question were the four answers to choose from. In researching for the answer I came upon this site and thought that I would put the question out there and maybe get some advice on what the first priority of the nurse would be. The assignment was designed to have questions like those that I would face on the NCLEX exam.